Integrating Behavioral Health into Your Practice

November 2, 2016

Approximately one in five people suffer from a mental illness in the U.S. It makes sense to address mental health issues in the primary-care setting.

I recently read an article that featured comments from a primary-care physician who indicated that it takes more time to see patients now than ever before. Not because of the EHR, but because patients have more complex issues. She focused on the need to address mental and behavioral health issues along with physical ailments. That's a good reason to start looking into how your practice can better meet the total needs of each of your patients. Other reasons include the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home Certification 2014 Integration Standards, improved payment models based upon recent laws (Mental Health Parity Act of 1996, Mental Health Parity and Addition Equity Act of 2008, and the Affordable Care act), all which make for a solid business case to consider your options for addressing behavioral health in your practice.

The first step is to honestly assess your needs by reviewing patient records for diagnoses, consulting all staff to identify patients by types of behavioral needs, and then to determine if there is a need that is not being met in your practice. This also includes an honest assessment of each provider in the office - addressing specific skills and interests in directly dealing with behavioral health issues. It has been estimated that approximately 18 percent of the U.S. population suffers from mental illness and approximately 8.4 percent suffer from substance use disorder. Therefore, it's possible that 26 percent of your patient panel could benefit from mental health services.

Once your practice decides to address mental health, you can pursue one of three options:

• One option is to work with outside entities that provide behavioral health services in a more direct, cross-referral model.

• The second is to co-locate, meaning that space is provided in the office for a behavioral health professional.

• The third option is to collaborate, meaning include a behavioral health professional into your practice.

It is interesting to consider the return on investment of the various options. There is little or no cost to option one. Option two may provide rental income. The third option requires funding.

As mentioned above, there are now federal laws that require reimbursement parity, e.g., a $20 copay could apply for a mental health visit, as well as a visit for a physical illness. However, it would be best to talk with your major payers to determine how they process claims, the patient data they require, etc. Even though there are laws it is better to be safe than sorry.

The level of service provided for patients will depend upon your continued assessment. Your patients can receive mental health services from many different types of professionals:

Job title (license)

Payment level*

Psychiatrist

100% of physician fee schedule

Clinical Psychologist

100% of physician fee schedule

Nurse Practitioner

85% of physician fee schedule

Physician Assistant

85% of physician fee schedule

Clinical Nurse Specialist

85% of physician fee schedule

Clinical Social Worker

75% of physician fee schedule

Licensed Professional Counselor

Not paid by insurance

Licensed Marriage and Family Therapist

Not paid by insurance

*Integrating Behavioral Health into the Medical Home, p. 83, 2016 Greenbranch Publishing

There are specific codes beyond the basic E&M codes that may be used for behavioral health. E&M codes work! 96150-96154, 90791, and 90832, 90834, 90837 are options to be considered, but consult the CPT book for specifics.

The bottom line is that there is a need to provide mental health care beyond the physical needs of many patients. Step one is to recognize the need. The next step is to take a serious look at how best to meet that need in your practice.